How to warn?
Sergey NAUMOV, oncologist, Candidate of Medical Sciences
Recorded by Alexander Rylov, the magazine "60 years is not age" No. 3-2016
One of the most characteristic malignant tumors of an elderly person is esophageal cancer. Now the risk factors for its development and the complex of "anxiety symptoms" are well known, clearly visible already in the early stages. Therefore, much in the prevention of esophageal cancer and in its early detection depends on the patient himself. Early diagnosis makes it possible to completely cure this disease in most patients
Erosions, ulcers, plaques and fungi
Esophageal cancer is the 6th most common in a number of malignant neoplasms. A malignant tumor forms on the wall of the esophagus, more often in the middle and lower parts of it. Its most common form (90% of cases) develops from the cells of the squamous epithelium covering the inner surface of this organ. In second place is adenocarcinoma, formed from the cells of the mucous glands of the esophagus.
There are two types of squamous cell carcinoma of the esophagus. Superficial cancer develops in the form of erosion or plaque on the walls of the esophagus. This tumor does not reach large sizes, later metastases and is easier to treat. Squamous cell carcinoma affecting the deep layers of the esophagus is much more dangerous (as well as adenocarcinoma). Such a tumor has the form of a fungus or ulcer, it quickly gives metastases.
All malignant tumors of the esophagus metastasize first to the lymph nodes, and distant metastases are given to the liver, lungs, bones, germinate into the trachea, bronchi and cardiac sac – pericardium.
Men suffer from esophageal cancer more often than women. Also, esophageal cancer is most often observed in elderly people after 60 years, up to 30 years this tumor is a rare disease.
"Esophageal cancer Belt"
The appearance of a tumor is promoted by smoking and the use of strong alcoholic beverages. These bad habits (and representatives of the stronger sex are more susceptible to them) increase the risk of developing the disease many times.
Excessive alcohol consumption is considered one of the main risk factors for esophageal cancer. People suffering from alcoholism suffer from it 12 times more often than those who do not have this addiction. If we talk about those who drink strong alcoholic beverages, especially alcohol, burning the mucous membrane and thinning it due to the destruction of the upper layer of cells, then their risk of getting sick is even higher.
Smoking increases the risk of esophageal cancer by 4 times. Harmful tobacco smoke products, especially nicotine, cause changes in epithelial cells, as a result of which the frequency of mutations (changes in hereditary material – DNA) increases in them, dangerous by the appearance of malignant cells. Chewing tobacco is a particular risk factor for esophageal cancer.
Permanent injuries and burns of the esophagus are also risk factors for this disease. Among the indigenous peoples of the North, Siberia and the Far East, the use of very hot tea, frozen fish and meat, hard cakes, which are sometimes also stored frozen in winter, is widespread. Such a diet, especially with irregular nutrition, as well as the abuse of pure or slightly diluted alcohol lead to permanent injury of the esophagus and increase the incidence of cancer in these regions so high that since the middle of the last century, a medical geographical term has developed: "esophageal cancer belt" (Northern Iran, Kazakhstan, Yakutia, some areas of China, Mongolia, the Far East). In addition, the peoples living in these areas also consume a lot of pickled, spicy dishes, and eat much less fresh vegetables and fruits.
So remember that in the prevention of esophageal cancer, the main role is played by the rejection of bad habits and compliance with the rules of food hygiene:
- quitting smoking and abuse of strong alcoholic beverages, especially alcohol;
- refusal to eat too hot and hard food;
- moderate consumption of pickled and spicy dishes;
- daily consumption of vegetables and fruits.
GERD is a gastrointestinal disease predisposing to esophageal cancer
The most common disease predisposing to esophageal cancer (but not yet precancerous) is gastroesophageal reflux disease (from Lat. oesophagus) – GERD. This chronic disease occurs due to violations of the motor function of the upper gastrointestinal tract (gastrointestinal tract). It is characterized by repeated throwing (reflux) of gastrointestinal contents (reflux) into the esophagus, which causes its main symptoms - heartburn and pain, and also leads to the development of various organic disorders of the esophagus.
So, the main risk factors for GERD are associated with gastrointestinal motility. These include:
- abdominal, that is, abdominal, obesity, in which adipose tissue squeezes the stomach, which significantly disrupts its motility and the work of the lower esophageal sphincter;
- refusal of a normal three meals a day in favor of a two- or even a one-time, evening meal, when a very large portion of food is taken;
- constant consumption of fast food - high–calorie, fatty and small-volume food;
- fast, hurried meals against the background of stress.
GPOD is a surgical disease predisposing to esophageal cancer
A very common cause of GERD and at the same time an independent mechanism of pathological reflux is gross mechanical damage to the esophageal–gastric junction, namely hernias of the esophageal orifice of the diaphragm (GPOD). These surgical diseases, in which the esophageal orifice of the diaphragm is displaced upward into the chest cavity, the abdominal part of the esophagus, part of the stomach, or both, never pass by themselves. And they inevitably progress, and medication and lifestyle correction have a small effect. Only surgery can lead to a complete cure. As a rule, GPOD, as well as GERD, develops due to improper nutrition. However, the causes of hernias are heavy physical labor, chronic constipation, and congenital increased elasticity of tissues that limit the esophageal orifice of the diaphragm.
To distinguish GERD in combination with hernia from "hernia-free" GERD is possible by the following signs:
- heartburn after eating increases significantly in a horizontal position and with physical effort;
- pain after eating occurs more often and is more pronounced than with "hernia-free" GERD;
- such pains often radiate to the sternum, heart region, shoulder blade, neck, lower jaw.
Precancerous diseases of the esophagus
The most dangerous is the so-called Barrett's esophagus, which is found in about one in ten patients with GERD, which very often degenerates into esophageal cancer, formed from mutated glandular or epithelial cells.
With Barrett's esophagus, an uncharacteristic cylindrical epithelium is found in the mucous membrane of the lower esophagus instead of glandular cells and a flat multilayer epithelium. In other words, cell degeneration begins, caused by chronic acid damage. Scientists are debating whether Barrett's esophagus can develop without an intermediate disease – chronic esophagitis, which also begins as a complication of GERD, or it forms only after esophagitis has begun. In any case, in some patients, Barrett's esophagus is detected without symptoms of esophagitis, which are very similar to the early signs of stomach cancer. A special danger to such situations is given by the fact that Barrett's esophagus does not have characteristic symptoms – this is a "mute" disease.
Is it possible to prevent the development of Barrett's esophagus?
The most reliable way to prevent this precancerous disease is to prevent the development of GERD and hernia of the esophageal orifice of the diaphragm by avoiding the risk factors that have already been described. If GERD has developed, and it is not cured by medications and becomes chronic, or a person suffers from two diseases at once – GERD and hernia, but he has contraindications to surgery to remove the hernia, and therefore GERD is not cured, then the gastroenterologist prescribes a regime of constant monitoring of the patient. Once a year, he should be shown to a doctor and once every 2-3 years undergo an examination – to do an esophagoscopy, which is the "gold standard" for the diagnosis of this tumor disease.
With the help of an endoscope, a thin tube at the end of which there is a tiny video camera, the doctor examines the esophagus from the inside. The tube is inserted through the patient's mouth, and the image is displayed on the monitor screen. At the same time, it is possible to see all the changes on the mucous membrane, including those characteristic of Barrett's esophagus. The endoscope allows not only to determine the size of the lesion, but also to take a tissue sample for histological examination.
If cell degeneration has begun, that is, Barrett's esophagus has developed, this does not mean that surgery is immediately required. The kind of cell degeneration is very important. The operation is offered only when a high–risk degeneration is established - the onset of adenocarcinoma.
In other cases, the doctor chooses a more rare or frequent mode of esophagoscopic examination and tries to make the drug treatment of GERD more successful in order to protect the esophageal mucosa from acid damage as much as possible.
If histological examination has proved that you have a degeneration of esophageal cells of the highest risk, and you are offered surgery, agree! There are such types of cellular degeneration, when almost 100% of patients develop adenocarcinoma after a maximum of 4 years, a very dangerous, very rapidly metastasizing tumor.
The first signs of esophageal cancer
Tumors of the upper and middle sections begin to manifest themselves only when the process of swallowing and moving food through the esophagus is disrupted, that is, dysphagia of the first degree occurs. This disorder occurs when the esophageal lumen is partially blocked by a tumor growing inside. The presence of another small tumor first causes mild spasms of the esophageal wall and, as a result, choking with solid food, while soft food and liquid are swallowed easily. When swallowing solid food, unpleasant sensations occur (burning, scratching, sometimes slight pain).
But when cancer occurs in the transition zone of the esophagus to the stomach, the first sign of a tumor is not a violation of the ingestion and promotion of food, but a constant regurgitation of air.
Belching, increased heartburn, nausea in many patients become the first symptom of the disease of all parts of the esophagus.
If you have persistent, that is, not passing for 7-10 days, signs of a violation of swallowing and moving food through the esophagus, then you need to consult a doctor in the coming days!
Late signs of esophageal cancer
The main among them are the symptoms of dysphagia of the II-V degree.
II degree of dysphagia. Solid food lingers in the esophagus and passes with difficulty, you have to wash it down with water. This stage of dysphagia is usually accompanied by copious salivation – a protective reflex that makes it easier for food to overcome obstacles. Food retention above the narrowing site leads to esophageal vomiting, regurgitation of saliva and mucus.
III degree. Solid food does not pass. When trying to swallow it, regurgitation occurs. Patients eat liquid and semi-liquid food.
IV degree. Only liquid passes through the esophagus.
V degree. Complete obstruction of the esophagus. Patients are unable to swallow a sip of water, even saliva does not pass.
Diagnosis of esophageal cancer
During diagnosis, in addition to esophagoscopy, a number of other examinations are performed.
Bronchoscopy. An endoscope is inserted into the respiratory tract to determine the condition of the vocal cords, trachea and bronchi. This is done to detect metastases in the respiratory organs.
Computed tomography (CT). This method allows you to estimate the size of the tumor and its germination into nearby organs, as well as the presence of metastases in lymph nodes and distant organs. Ultrasound is used for the same purposes, but the sensitivity of this method is lower than CT.
Laparoscopy. A puncture is made in the abdominal wall in the navel area and a thin flexible tube of a laparoscope is inserted. At its end there is a video camera and tools for manipulations. Starting from the liver, in turn, clockwise, an examination of all abdominal organs is carried out and material is taken for the study of neoplasm cells – biopsy and puncture of the tumor. The procedure is performed in the case when other diagnostic methods did not allow to determine the metastases of the esophageal tumor to the abdominal organs.
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